Higher than average painkiller abuse and ever-increasing overdose deaths are driving a statewide effort to push doctors to follow more stringent regulations when they prescribe pain medications.

Medical providers are mixed on the mandatory regulations, which specifically clamp down on the amount of opioid medication a doctor can prescribe for an acute injury or procedure. The initial maximum would be a seven-day supply.

Prescribing beyond that quantity would require a thorough check of the patient's history in the Prescription Monitoring Program and for doctors to present information about the risk of addiction and abuse and get a patient's informed consent.

Those with chronic pain would need to sign a treatment agreement and take urine drug screenings twice a year. Doctors would also need to discuss alternative treatment options for pain.

Opioids that would be under tighter regulation include morphine, codeine, fentanyl, meperidine and methadone.

According to a Centers for Disease Control and Prevention analysis from 2012 on prescribing patterns, Delaware prescribed the second highest rate of long-acting or extended-release opioid pain relievers and the highest rate of high-dose opioid pain relievers.

The guidelines aren't going to fix Delaware's drug abuse epidemic single-handedly, but it is a step forward, says Delaware Secretary of State Jeffrey Bullock

"These I don’t think are undue barriers and shouldn't interfere with treatment. At the same time, they put some safeguards in place to prevent some unintended consequences," Bullock said. "I don’t think you can completely change human behavior by writing new laws or issuing new regulations."

The guidelines would affect primary care doctors, dentists, podiatrists, nurse practitioners and physician assistants, but would not subject veterinarians, pharmacists or hospitals to the limits.

Dr. Ganesh Balu, a pain management physician with the Comprehensive Spine Center, said the seven-day limit is too stringent to broadly have for all patients to follow. Though it is possible to increase dosage, he is unsure how many times the physician would need to educate the patient on addiction and pain management. The staff infrastructure is not there, he said.

"At the end of the day, physicians are taking more of the burden and the burden as only increased," he said. "It's a social problem. It's not a medical problem anymore.
Its reflective of our society, which is going down."

Many who become addicted to painkillers, eventually move on to heroin.

The News Journal detailed in a more than yearlong series the rise of heroin use across the state and the impact it has had on users and their families and the communities they live in.

As the problems still persist, state officials have increased treatment options and created a commission to study why Delawareans are overdosing.

Doctors will face disciplinary action if they are found to not be following the new guidelines, Bullock said. Ultimately their controlled substance license could be revoked if found in violation. There will not be any random checks or audits of medical offices.

"We rely heavily on our medical community to conduct themselves in a professional way, to follow the regulations that are set by the state," Bullock said.

The number of pills prescribed in a acute care patient's seven-day supply would vary. These patients are typically recovering from injuries or procedures that would take about 30 days to temper.

Dr. Debra Pace, a member of the state Prescription Drug Action Committee, said most doctors will favor the guidelines, but they are going to have to come with re-educating patients on pain management and suggesting alternative, more holistic treatment.

"Patients are often very resistant to that. They just want to pop a pill," she said.

For instance, Pace, a dentist with a specialty in endontics, said that most dental procedures can be managed with over-the-counter pain relievers like ibuprofen or acetaminophen.

Dr. Karyl Rattay, director of the state Division of Public Health said acupuncture, physical therapy and mind-body medicine, such as yoga and meditation are much more safer alternatives to managing chronic pain.

"It is debatable by some pain management doctors," she said. "The usage of opioids for chronic pain is really debatable."

MaryBeth Cichocki, a member of the advocacy group atTAack Addiction, was desperately wondering when her son Matt's pain management doctor would suggest acupuncture to relieve his lingering back pain.

Instead, he received about 168 Percocet pills a month after a back surgery. Matt struggled for two years before overdosing on painkillers, Xanex and anti-depressants in January 2015

"You can't live on long-term opioids," Cichocki said. "Man created this epidemic and only man is going to be able to stop it."

The overarching goal is improve the current process to ensure patients have access to safe chronic pain treatment, while reducing the number of people who misuse or tragically overdose from opioids.

More than 200 people fatally overdosed in Delaware in 2015. According to the state, 90 percent of heroin users began abusing with prescription opioids.

Growing up in Wilmington, Mike Gamaitoni dabbled in painkillers at the height of Delaware's opioid crisis in 2004 and 2005. Everyone he'd reach out to for pills, he said, had a leftover stash from a car accident or sports injury. After a year he was addicted.

Issuing new regulations for doctors is a start, he said, but there needs to be more accountability.

"It’s kind of like putting a Band Aid on a a gun shot wound," said Gamaitoni, now a community outreach representative at Transformations Treatment Center in Florida.

"It opened up a door that they are trying to close, but they waited way too long to close it,"

The new guidelines are out for public comment through May 31. Email christine.mast@state.de.us to submit comments.

Jen Rini can be reached at (302) 324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.